"You can't wear my colors in your hair!"

A few years ago, I had a small midlife crisis and decided to color some of my hair purple. I figured it was cheaper than a Corvette and less permanent than a tattoo.

Reactions to my hair ranged from neutral to enthusiastic. At that agency, I was expected to dress business casual most days and more formally for important meetings and occasions, but my hair was relatively free of restrictions. My co-workers were amused, and clients either ignored or appreciated it. “Hey, Demi Lovato!” was more or less the reaction, if they noticed.

But after I asked Jesse to let our receptionist get back to her work – he was intently trying to explain his theory of why Puerto Ricans are their own worst enemy and hold themselves back, while she smiled nervously at him from behind the reception counter – he took offense and snarled, “Leave me alone! I'm allowed to talk to people! You can't tell me what to do! You can't wear my colors in your hair!”

Purple and gold are the colors of the Latin Kings. I hadn't known Jesse ran with them. Every other encounter I'd had with him had been very pleasant. Diagnosed with bipolar disorder and in recovery from marijuana and cocaine addiction, he was doing well at our clinic and had just been accepted into a supportive housing program.

“I'm so happy,” he said. “I'll finally have a place of my own, where I can heal.”

“I'm happy for you,” I said. But weeks after he received the good news, his mania erupted. Initially euphoric, he followed our receptionist around the clinic. She is sweet-natured but not always assertive; when I stepped in to assist her, Jesse was first annoyed and then furious.

“What's going on, Jesse?” asked his counselor, who was drawn to the reception area by the sound of Jesse's voice raised in anger. “Come on, let's talk about this.”

“Nothing to talk about,” Jesse snarled. “What is it with all these Dominicans? Where did they come from? They're the garbage of the universe!”

I'm not sure if Jesse thought I was Dominican; most people in New York assume I'm Puerto Rican, and I'm actually Jewish. As he raged, I noticed a purple bandanna dangling from his jeans pocket.

Am I in real danger? I wondered. I was relatively new on the job; I didn't know what his baseline was, but anger and aggression seemed out of character for him. His counselor appeared dumbfounded. After Jesse stormed out, she said, “I have never seen him like this. I've known him for some time now, and he has never acted out this way.”

We checked his chart and found that he had signed a consent for us to speak with his psychiatric providers (our clinic did not provide psychiatric medication management). Although his psychiatrist was on vacation, the covering psychiatrist was able to check Jesse's chart and told us that Jesse hadn't been taking any medication for almost six months.

Sometimes good news can be as destabilizing as bad news for someone with bipolar disorder. It seemed to me that in Jesse's case, securing a spot in a housing program might have triggered his mania. Soon we received a call from the psychiatric ward of a local hospital. Jesse had been admitted. The hospital social worker asked me, “Do you think he's a threat to himself or anyone else?”

All too often, that's the deciding factor in emergency psychiatric treatment. Does the person express suicidal or homicidal ideation? If not, he or she might be released, even if in desperate need of treatment.

“Well, he did tell me not to wear his colors in my hair,” I said, explaining my midlife crisis dye job. “And he was carrying a purple bandanna.” Flying gang colors – and his words to me – could be perceived as a threat. So the hospital kept him.

Initially resistant, Jesse started taking medication after a few days on the ward, and gradually stabilized. He came to see me after he was released.

“I wanted to apologize for how I talked to you last time I was here,” he said, “There's a guy at my shelter who's been giving me a real bad time. I try to just avoid him, but he won't leave me alone. We used to get high together, and when I stopped, he started threatening me. Saying he was going to have his bangers put a beat down on me.” I wondered if that guy was Dominican, but didn't ask; my idle curiosity doesn't always further a clinical purpose. This did explain why Jesse had started carrying the bandanna.

“I remembered learning in anger management group here that you should just walk away from a fight,” Jesse continued, “so I did, and then he hit me with a paving stone in the back. Blood came out of my nose. I had to go to the emergency room.” He pulled out discharge paperwork and showed me the instructions he was given for taking care of a cracked rib and bruised lung.

“When I came back to the shelter, the house manager called the police to arrest the guy, but I...” His voice trailed off. “I started talking really fast, and I wasn't making much sense. Because I was so mad. The police ended up taking me to the hospital.” He hung his head. “I wanted you to know that it wasn't you I was really mad at. I was more taking it out on you.”

“It's okay,” I said. “I knew there was something going on. I could tell you weren't yourself, something else was really bothering you. Now that you've explained about that guy, I totally get it. You were angry and scared. I didn't take it personally.”

“I was afraid you wouldn't let me back in the program,” he said.

“Well, you should know first of all that I don't have that kind of absolute power here,” I reassured him. “But we understood what was going on, and we were hoping you'd get better; that's why we kept in touch with your hospital social worker and didn't discharge you. It's nice to have the real Jesse back.”

Jesse enrolled in outpatient psychiatric treatment close to our clinic, and soon he moved into his new apartment.